And the good news is…
Sometimes it takes a conversation with a friend to actually define what one was always doing. Life and work go on as a routine and it isn’t often that I am able to introspect on what is going on. Pausing a moment, taking stock, reviewing my work doesn’t happen a lot – as long as things go on, there is no compulsion to do that.
Last night, I chanced upon an old friend from UK online – a public health researcher, we ended up talking about our work. Post that conversation, I lay awake awhile, thinking about the work that I do.
The bulk of my patients have diabetic retinopathy in various stages. Being a welfare state and an affluent one at that, there is a real problem with obesity and poorly controlled diabetes. Add to this, probable ethnic and genetic factors which dispose to the disease and one ends up with a prevalence of diabetes which is staggering.
Diabetic retinopathy is, frankly, not a nice thing to have. Inexorably progressing, the patient and the treating doctor, most of the time can only exercise what can be euphemistically termed – damage control. Yes, it is true, that disciplined control of blood sugar with a regulated lifestyle and exercise can help control the disease process a great deal… but… a lot of diabetics don’t fall into the regulated/disciplined category. The result is what I mentioned earlier, inexorable progression.
Advanced diabetic retinopathy
Therefore, I find myself, increasingly in the unenviable position where I have to tell my patients that their eyesight is diminishing and whatever treatment I have in my armamentarium can at best only keep it at whatever level it has fallen to. Shorn of all its euphemisms and gentle language, here’s what the dialogue would be like:
Me:Tough luck, you have diabetes retinopathy
Patient: What does that mean?
Me: It means that your vision is going to steadily become worse
Patient: Can’t you treat it?
Me: Not really, I can do some laser and stuff and try to prevent it from deteriorating further
Patient:Good, so you can stop it then..
Me: Nope, I guess I can slow it down
Patient: You mean, my vision is going to come down even with all that treatment?
Me: Most probably
Patient : Are you nuts?
Me: No, and you can pay my secretary on the way out.
You guessed it, my diabetic patients aren’t the happiest lot around. If only I could convince them, that the best thing that was happening to them is going blind slowly…
Researchers, are you listening?? I am the guy, who needs to talk to the patients!!
